State causes of hyperbilirubinemia.
Discuss the pathophysiology of
Describe the most dangerous complication
List the three elements of therapeutic
Design plan of care for baby has
Hyperbilirubinemia refers to an
excessive level of accumulated bilirubin
in the blood and is characterized by
jaundice, a yellowish discoloration of the
skin, sclera, mucous membranes and
Unconjugated bilirubin = Indirect bilirubin.
Conjugated bilirubin = Direct bilirubin.
5. Risk factors for jaundice
• J - jaundice within first 24 hrs. of life
• A - a sibling who was jaundiced as neonate
• U - unrecognized hemolysis
• N – non-optimal sucking/nursing
• D - deficiency of G6PD
• I - infection
• C – Cephalhematoma /bruising
• E - East Asian/North Indian
10. MECHANISMS OF NEONATAL
1.Increased Bilirubin Load due to a high
• The normal newborn infant
• Cephalhematoma or bruising , Polycythemia
2. Decreased Bilirubin Conjugation in the liver
• Decreased uridine glucuronyl transferase Activity
• Glucuronyl Transferase Deficiency Type 1 (Crigler
3. Defective Bilirubin Excretion
32. In single volume exchange (in severe
neonatal anemia): A suggested rateis15 aliquotsover 1
hour that is, 4 minuteseach cycle.
numberof aliquots in1hour= 85mlxweight(kg)Itis usually
In double volume exchange: A suggested rate
is 30 aliquots over2 hours that is, 4 minutes each cycle. This
is irrespective of whetherthe isovolumetric orpush-pull
method is used.
(kg)/numberof aliquots in2hours = 85mlx2xweight(kg)itis
35. Isovolumetric exchange- access is via
an umbilical venous catheter(blood in)
and an umbilical arterial catheter(blood
Push pull method- using same catheter
that is the blood are pushed in pulled out
through the same umbilical venous
43. Check the patients chart forsigned exchanged transfusion order
Check consent form signed by parents
Ensure exchange blood unit is available in the blood bank and have it brought to area just prior
Obtain received amount of blood from blood bank. Double check the blood pack with another
nurse to ensure correct identification.
Equipment forumbilical catheterization must be available including:
Clean equipment sterile equipment
Clean dressing trolley, blue sterile plastic sheet to place understerile drape
IV infusion pump
3.0 silk suture, sterile linen, cord tie, scalpel blade, tape measure
PPElike: masks protective goggles, sterile gown, two sets of sterile gloves, sterile green
drapes, sterile dressing, additional gauze swabs, assorted needles/5 ml syringes
Unopened solutions forskin preparation(aqueous chlorhexidine)
UVC 5 Finfants 1000g and <28 weeks and 3.5 Finfants <1000g or>28weeks
Prepare the infant fortransfusion, afterchecking the identification band, keep NPO, Evacuate
gastric contents through a 8G=FG feeding tube and leave on free drainage; obtain baseline vital
signs and blood pressure.
Infants > 34weeks gestation are placed on servo mode but < 34weeks are managed in isollete.
Access forprocedure: insertion of 5 FG umbilical catheterby physician to a level that allows free
flowing withdrawal of blood
Patient should be on continuous cardiac monitoring
Secure the infant’s upperand lowerextremities as perrestraint policy
Maintain the infant’s temperature with radiant warmeron servo control, take the infant’s
temperature at least hourly oras ordered
44. Standard precautions and aseptic technique should be
The physician will connect the umbilical catheterto the
first adaptoron the 4-ways stopcock
Take a 20cc syringe from the tray, and attach to the
second adaptoron the way stopcock
Attach the blood administration set with extension tubing
to the third adaptoron the 4-way stopcock
Connect the remaining adaptorof the 4-way stopcock to
the waste blood containerand secure properly below the
Draw pre-exchange laboratory work including dextrose
The nurse must observe the infant and record the amount
of blood out and amount of the blood in and time
Document heart rate, respiratory and blood pressure
every 5 minutes and inform physician of any changes in
the vital signs
45. Blood Specimens
Initial or “First Out”.
FBC & film.
Blood Group, Direct Coomb's test.
Urea and electrolytes, calcium, SBR, total and conjugated.
Blood gas with PGL.
Newborn screening test.
Hold samples for other tests as indicated, e.g. G6PD deficiency, viral infection,
hereditary spherocytosis, metabolic studies.
Blood gas with PGL
FBC/Coagulation screen if warranted
End or “Last Out” specimens
SBR, Urea & Electrolytes, calcium, magnesium, phosphate.
FBC and Cross match for possible subsequent exchange.
Blood gas with PGL
Measure serum bilirubin within 2 hours
46. NICU Exchange Transfusion Chart
Date : Aliquots (circle one):
5 ml 10 ml 20 ml
Cycle Time Volume out Total
Volume in Total in HR RE BP T SPO2 BSL